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Daniel Y. Lee, Justin M. Spaulding, Paul M. Kitei, Robert J. Goulet, III, James F. Vander, Scott J. Fudemberg; Sustained Intraocular Pressure Elevation Following Intravitreal Injection of Ranibizumab and Bevacizumab for Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5090.
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To determine the prevalence of sustained intraocular pressure (IOP) elevation among patients treated for exudative age-related macular degeneration (AMD) with intravitreal injections of the vascular endothelial growth factor (VEGF) inhibitors ranibizumab and bevacizumab.
Retrospective review of patients treated for AMD with intravitreal injections of ranibizumab or bevacizumab at the Wills Eye Institute office of Mid Atlantic Retina between 2007 and 2010. Patients with diabetes mellitus, glaucoma, or retinal vascular occlusive disease were excluded. Patients previously treated with glaucoma medications or corticosteroids were excluded. Baseline IOP was defined as the last measured IOP prior to injection. Sustained IOP elevation was defined as ≥30% increase from baseline IOP measured on either two consecutive visits over a minimum of 30 days or a single visit if IOP-lowering therapy was initiated.
379 patients (459 eyes) received intravitreal injection of ranibizumab or bevacizumab, ranging from 1 to 39 injections (mean 8.4). Seventy-two eyes (16%) developed sustained IOP elevation. Among this population, eight eyes (2%) developed IOP elevations greater than 21 mmHg, with a mean baseline IOP of 13.8 mmHg and mean maximum IOP of 24 mmHg (range 22 to 27 mmHg). In these eyes, the mean number of injections prior to IOP elevation was 3.9 (range 1 to 12). None of the eyes in this study required treatment for elevated IOP.
None of the patients in this study experienced a clinically significant sustained IOP elevation. The prevalence of elevated IOP following intravitreal injection of ranibizumab or bevacizumab may be much lower than previously reported. Different techniques used to prepare bevacizumab for intravitreal delivery may contribute to the variable prevalence among institutions. This study attempted to minimize confounding variables by enrolling AMD patients without diabetes mellitus, glaucoma, retinal vascular occlusions, and history of corticosteroid treatment. However, it is unknown whether such patients are predisposed to sustained IOP elevation after treatment with VEGF inhibitors.
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